title: Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP.
  
  
  OBJECTIVE
  We recently conducted a national collaborative aimed at reducing health care-associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases.
  
  
  METHODS
  This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections.
  
  
  METHODS
  The setting of the study was 110 ICUs at 61 HCA hospitals.
  
  
  METHODS
  None.
  
  
  RESULTS
  We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients.
  
  
  CONCLUSIONS
  We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem.
authors.affiliation: Pulmonary, Critical Care and Sleep Disorders Medicine, Southlake Clinic, Valley Medical Center, Renton, Washington 98055, USA. brickw@u.washington.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wall
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Weinger
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Joan
authors.initials: J
authors.lastname: Reischel
authors.forename: L Hayley
authors.initials: LH
authors.lastname: Burgess
authors.forename: Jane
authors.initials: J
authors.lastname: Englebright
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Jayant K
authors.initials: JK
authors.lastname: Deshpande
mesh_terms: D000465:Algorithms; D019317:Evidence-Based Medicine; D006777:Hospitals, Proprietary / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012122:Ventilators, Mechanical / Q000009:adverse effects*